| Objective: Cesarean section is still one of the most common obstetrics and gynecology operations.Incision pain and visceral pain is a process that every women must go throuth.After cesarean section,due to the sum of the pain of the uterus and abdominal wall,it can lead to moderate to severe postoperative pain.Poor control of postoperative acute pain,maternal physical weakness,emotional anxiety,newborn need to breastfeed and other complex conditions,together with pain affecting maternal,will cause a very adverse impact on maternal recovery.Traditional opioid analgesics have good analgesic effects,but the incidence of adverse reactions such as nausea,vomiting,pruritus,drug secretion through milk and respiratory depression is high.Compared with traditional opioid analgesics,ketorolac tromethamine has the effect of inhibiting visceral pain with less adverse reactions.Meanwhile,transversus abdominis plane(TAP)block is effective for incision pain.Therefore,in this study,intravenous controlled infusion of Ketorolac tromethamine combined with TAP block was applied to patients after cesarean section to observe the analgesic effect on incision pain and visceral pain.Methods:A total of 90 patients who underwent cesarean section under combined spinal-epidural anesthesia in the Department of Obstetrics of the Second Affiliated Hospital of Dalian Medical University from November 2019 to December 2020 were selected.They were divided into three groups using random number table method(n=30 each):PCEA group(group E),PCIA group(group I),PCIA+TAPB group(group T).In group E,PCEA was performed at the end of surgery,with the regimen of 0.125%ropivacaine and 0.3μg/ ml sufentanil in 200 ml.The background dose was 5ml/h.The bolus dose was 3ml.And the locking time was 30 min.In group I,PCIA was performed at the end of surgery,with the regimen of ketorolac tromethamine 180 mg and ramosetron 0.6mg and 0.9% sodium chloride solution to 150 ml.The background dose was 0.5ml/h.The single dose was 4ml.And the locking time was 60 min.The patients in group T received ultrasonic-guided bilateral transverse abdominal plane block immediately at the end of surgery:0.3% ropivacaine and 0.5μg/kg dexmedetomidine20 ml were injected into each side.The PCIA regimen was the same as that in group I.When the resting NRS score ≥4 points after surgery,one dose of remedial analgesia was given(Intramuscular morphine 10mg).The following was recorded:the NRS pain score at resting,cough and uterine contractions at 6h(T1),12h(T2),24h(T3)and 48h(T4)in the three groups;Ramsay sedation score;the number of pressure of postoperative analgesia pump in group Ⅰ and group T within 48 h after operation;the number of patients who required rescue analgesia in the three groups within 48 h after operation;analgesia-related adverse reactions within 48 h after operation(the incidence of nausea and vomiting,pruritus,respiratory depression,adverse gastrointestinal reactions)and lower limb motion block(modified Bromage grading)12 hours after surgery;patient satisfaction with pain management.Results:There was no significant difference in general data between group I,T and E(P > 0.05).At T1 and T2,the difference of the NRS pain score at resting between the three groups was statistically significant(P < 0.05),the NRS pain score at resting of group T was the lowest,and the difference was statistically significant with that of group Ⅰ and group E(P < 0.05),the difference between group Ⅰ and group E was not statistically significant(P > 0.05).At T3 and T4,the difference of the NRS pain score at resting between three groups was not statistically significant(P > 0.05).At T1 and T2,the difference of the NRS pain score during coughing between three groups was statistically significant(P < 0.05),the NRS pain score during coughing of group T was the lowest,and the difference was statistically significant with that of group Ⅰ and group E(P < 0.05),while the difference between group Ⅰ and group E was not statistically significant(P > 0.05).At T3 and T4,the difference between three groups was not statistically significant(P > 0.05).There was no significant difference in the NRS score during uterine contraction among the three groups at the four time points(P > 0.05).The number of effective pressing in group Ⅰ was significantly higher than that in group T,and the difference between the two groups was statistically significant(P < 0.05).All the women in the three groups were in a quiet and cooperative state during follow-up at four time points.No rescue analgesia was performed within 48 hours after surgery in the three groups.The incidence of analgesia-related adverse reactions in group E was10%(there were 2 cases of nausea and 1 case of pruritus),which was significantly higher than 0% in the other two groups(P < 0.05).The satisfaction score of group E was significantly lower than that of group T(P < 0.05),while there was no statistical difference between group Ⅰ and group T(P > 0.05).Conclusion: For patients after cesarean section,transverse abdominal plane block combined with ketolorac tromethamine can reduce the NRS scores at resting and coughing within 12 hours after operation,reduce the degree of pain and reduce the occurrence of adverse reactions such as nausea,vomiting and pruritus,and improve patient satisfaction. |
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